Drug delivery device

ABSTRACT

The present disclosure presents systems, devices and methods for injection of drugs, substances and/or chemicals to a patient and for improving their effectiveness once they are injected are disclosed. Additional treatment can be applied to a tissue region on the patient into which a drug (e.g., insulin) is injected, to expose the tissue region to various forms of energy or a substance to improve the drug&#39;s pharmacokinetic and/or pharmacodynamic profile.

CROSS-REFERENCE TO RELATED APPLICATION

The present invention claims priority to U.S. Provisional PatentApplication No. 60/895,518, filed Mar. 19, 2007, U.S. Provisional PatentApplication Ser. No. 60/895,519, filed Mar. 19, 2007, U.S. ProvisionalPatent Application Ser. No. 60/912,698, filed Apr. 19, 2007, U.S.Provisional Patent Application Ser. No. 60/940,721, filed May 30, 2007,U.S. Provisional Patent Application No. 61/016,571, filed Dec. 25, 2007,U.S. Provisional Patent Application No. 61/008,277, filed Dec. 18, 2007and U.S. Provisional Patent Application No. 61/010,758, field Jan. 10,2008, and U.S. patent application Ser. No. 11/812,230, filed Jun. 21,2007, the disclosures of which are incorporated herein by reference intheir entireties.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to systems and methods for deliveringdrugs to a patient. In particular, the present invention relates tosystems and methods for subcutaneous injection of a medicament and usingone or more treatment sources to improve effectiveness of the injecteddrugs.

2. Background of the Invention

Pen injectors are useful when regular injection by persons withoutformal medical training occurs. This is increasingly common amongstthose having chronic conditions such as diabetes where self-treatmentenables such persons effectively manage their condition. Many of theinsulin pen injectors are reusable and usually loaded with an insulincartridge that may be used for a plurality of injections or for a numberof days. Many other diabetic patients use regular syringe(s) and needlesfor insulin injection.

Diabetes is a very serious illness affecting millions of people today.Many diabetic patients require injections of insulin to maintain properlevels of glucose in their blood in order to survive. Such injections ofinsulin require drug injection systems.

Many medical treatment systems and methods involve drug injectionsystems that employ subcutaneous injections of therapeutic fluids,drugs, proteins, and other compounds. Such delivery systems and methods,especially for insulin delivery, may use injection pens to injectinsulin to the subcutaneous tissue, or regular syringe. In theconventional insulin injection pens, the pen includes a disposableinsulin reservoir and a disposable needle through which insulin isinjected into the tissue. The needle is a single use needle, while theinsulin reservoir can be used for two to three days. In the conventionalinsulin injection pens, the injection is done by attaching the insulininjection pen to the skin at the injection site and pressing a buttonthat first insert the needle using a spring into the subcutaneous tissueand then inject the insulin to the subcutaneous tissue.

In many instances, the patients require insulin injection around theclock to keep proper levels of glucose in their blood. Two major typesof insulin can be injected—a long-acting insulin that provides the basalinsulin rate needed for keeping patient's blood glucose in the desiredrange between meals and over night and an insulin bolus injection thatprovides an amount of insulin for matching a dose of carbohydratesconsumed by the patient.

When patient consumes food, his or her levels of glucose rise.Unfortunately, many conventional subcutaneous injection devices areincapable of quickly matching and/or preventing the rise of bloodglucose. The delay in such matching is also true in case of the“rapid-acting” insulin. Some of the reasons for this delay include a lagin the absorption of insulin from the injection site and the time ittakes for complex insulin molecules to break down into monomers.

Additionally, since blood glucose levels rise shortly following themeal, the delay in matching insulin to the rising levels causes postprandial hyperglycemic events (i.e., when levels of blood glucose areabove normal) to occur. Occasionally, after certain period of timepasses (e.g., 2-3 hours) after the meal, the blood glucose levels dropyet insulin concentrations in the blood rise followed by the peak of thesystemic insulin effect and may result in causing hypoglycemic events(i.e., when levels of blood glucose are below normal) to occur. Bothhyperglycemic and hypoglycemic events are highly undesirable.Additionally, since local blood perfusion at the insulin injectionregion has large variability, depending on the ambient temperature andother parameters, it induces large variations to the delay of the peakof time profile of the insulin action. Those variations in the insulinpeak action period further increase the variability in the blood glucoselevel.

Thus, it is desirable to provide a system and a method that providesefficient and rapid injection and absorption of the drug to the patientcirculatory system. In particular, it is desirable to provide a systemand a method for injection of insulin to the patient that improveseffectiveness of insulin in the blood to maintain normal levels of bloodglucose and prevent or reduce hyperglycemic and hypoglycemic events.

SUMMARY OF THE INVENTION

The present invention relate to systems, devices and methods forinjecting a drug, substances and/or chemicals to a patient that furtherprovides a tissue treatment element for improving the effectiveness ofdrug delivery upon injection. In some embodiments, the present inventionrelates to a device for improving performance of drug delivery in theform of injection pens or syringes. In general, the present invention'ssuggested methods and devices can be used in many drug injectiondevices, such as injection pen(s), syringe(s), or jet injector(s), orother injection devices. As such, although the present applicationdiscusses mainly injection pens, it is understood by one skilled in theart that such devices can be used with any other injection devices. Insome embodiments, the present invention provides for a device thatfurther provides an additional treatment to a tissue region where thedrug is delivered. In some embodiments, the treatment is utilized toimprove drug delivery process by improving the drug's pharmacokineticand/or pharmacodynamic profile. The treatment may come in various forms,for example, including analgesic, vasodilator or the like. The treatmentmay be any form of treatment that leads to improved vasodilatation ofthe tissue being injected, including but not limited to, exposing thetissue region to an energy, radiation, heat, mechanical vibrations,suction, massaging, acoustic stimulation, electromagnetic radiation,electric field, magnetic field, electrical stimulation, injection of anadditional substance(s), or any combination of the above to improve thedrug's pharmacokinetic and/or pharmacodynamic profile. Each treatmenttype may have a separate protocol in order to evoke the necessaryreaction such as vasodilatation or the like.

In some embodiments, the present invention provides a needle free drugdelivery pen that is coupled to a treatment element. The treatmentelement improves the pharmacokinetic and/or pharmacodynamic propertiesof the drug that is being delivered to the target tissue using a fluidjet. The drug delivery injector for administering a drug, for example,insulin, as a jet nozzle configured for firing insulin in a fluid jet ina configuration and with sufficient velocity to penetrate tissue of thepatient to a delivery site. A drug containing compartment is associatedwith the nozzle for containing the drug and feeding the insulin to thedelivery nozzle for injection. A firing mechanism includes an energysource is associated with the drug compartment for forcing the drugthrough the nozzle at a sufficient velocity to penetrate to the targetsite. In some embodiments, the energy source producing the fluid jet canbe a coil spring, gas spring, or any other spring. A trigger or a dosagerelease button of the drug delivery injector is movable by the user andassociated with the firing mechanism for activating the energy sourcethat produces the drug fluid jet by forcing of the drug through thenozzle once the release button is activated.

In some embodiments, the applied treatment induces vasodilatationthrough neural stimulation of the tissue of the drug injection site. Theneural stimulation can be induced by thermal stimulation and/ormechanical stimulation and/or chemical stimulation. The human neuralresponse to the thermal stimulation includes several mechanisms such asthe Nociceptive Axon Reflex that induce vasodilatation among othereffects.

In some embodiments, the induced neural response, such as theNociceptive Axon Reflex, also induces widening of the capillary poresand increasing the capillary wall permeability. This effect is alsosignificant for improving the absorption of the drag through thecapillary wall.

In some embodiments, the applied treatment may lead to a reduction inthe variability of the drug absorption in the blood or lymph system andits local and systemic effects. For example, heating the tissue regionin the vicinity of the area of drug delivery to a preset regulatedtemperature during and/or after the drug injection and absorption intothe blood may cause local blood perfusion at that region to become morereproducible and the drug absorption process more uniform andreproducible as well. Also, by reducing the delay between drug injectioninto the tissue and absorption into the blood system, the variability ofdrug action induced by the delayed profile can be reduced. In someembodiments, the temperature of the region adjacent to the injectionregion can be regulated for longer periods, but the cost may be theenergy source volume and weight. Therefore, for minimization of theenergy source size, the heating period or heating temporal profile canbe optimized in relation to the period of the drug injection andabsorption into the blood. In some embodiments, in which the treatmentutilized is, for example, heat, the drug interaction with the treatmentsubstance or type will be taken into consideration and can be avoided.For example, a drug's temperature sensitivity will be accounted for soas to avoid protein denaturisation. Insulin is a temperature-sensitiveprotein and to avoid damage to the insulin the treatment protocol,heating can be limited to ensure the efficacy of the delivered drug. Forexample, the treatment protocol may control the temperature or thelocation of the treatment delivery site so as to not damage the drug.

In some embodiments, the neural response that induces vasodilatation isstimulated by applying a mechanical force in the vicinity of the druginfused region, wherein the force includes, but is not limited to, oneor more of the following: pressure, massage, vibration, suction and/orany other mechanical stimulation. These tissue treatments orstimulations are known to stimulate the Nociceptive Axon Reflex as well.Among the advantages of the mechanical stimulation is the fact that itdoes not damage the drug, whereas for example heating insulin above 37°C. may cause damage to it. The calibration of the applied mechanicalforce may be performed by using one of the procedures discussed above.

In some embodiments, an additional fluid substance can be combined withthe drug or, alternatively, injected, infused, or topically applied(which may include transdermal delivery of the drug by permeatingthrough the skin of the patient) to the drug injection site, such thatthe additional substance induces neural stimulation that leads to localvasodilatation and/or increases of the capillary permeability. Thesubstances can include tolazine, naftidrofuryl, suloctidil,nitroprusside, capsaicin, or any other suitable substance. In someembodiments, an additional substance may induce vasodilatation andimprove blood perfusion in the drug infused tissue region. For example,capsaicin stimulates a neural response through the VR1 receptor andproduces a similar response to thermal neural stimulation.

The treatment element can be an integral part of the drug deliveryinjection pen, according to some embodiments of the present invention.In some embodiments, the treatment element can be an auxiliary unit thatmay be interchanged, replaced, or added to an existing drug deliveryinjection pen. Such a device can be attached to the drug delivery peneither during or before the drug injection or applied to the druginjection site afterward.

The treatment element, according to some embodiments, may be any one ormore of (or a combination of): a heating element, a radiation emitter, asound transducer, a mechanical/electo-mechanical vibration device, alight emitting device, and an electrode.

In some embodiments, one or more of properties relating to the treatmentelement may be controlled by a processor in order to achieve a desiredresponse of the tissue region undergoing drug delivery. Such propertiesinclude amplitude, phase, frequency, combination of excitation sources,relative ratio and timing between various excitation sources, or anyother properties. In some embodiments, the treatment type or sources canbe also adjusted according to chemical and/or physical properties of thedrug being delivered. The tissue response to the treatmentelement/stimulation enhances the functionality of the injected drug byenhancing the kinetics of molecular transport from the injection siteinside the tissue to various compartments surrounding the tissue regionand to the blood system.

In some embodiments, a treatment element or device supplying tissuetreatment or stimulation to a tissue region can be configured to monitorand control properties of the treatment source. For example,controllable properties of a treatment protocol include amplitude,phase, intensity, frequency, or any other properties. Further controlcan be gained by actively monitoring, such that the information isprovided to a controller (“controller” or “processing unit”) that usesthe information to reduce the variability of the drug pharmacokinetics.In such embodiments, the device can be configured to monitor propertiesof the adjacent tissue, such as local blood perfusion or skintemperature. Based on such monitoring, the information can be providedto the controller that utilizes the information to improvepharmacokinetic or pharmacodynamic profile of the drug as well as itsperformance and reduce variability of the drug injection process.

In some embodiments, the present invention's device includes a sensor orother triggering input mechanism that is configured to preventdeployment of the drug delivery pen unless certain criteria arefulfilled. Such criteria can include activation of a treatment protocolor element.

In some embodiments, tissue treatment can be applied simultaneously witheach injection of the drug delivery. In other embodiments, the tissuetreatment or stimulation option may be selected manually by the user. Insome embodiments, the user may choose to attach the treatment element tothe drug delivery pen. The user can enable or disable mechanically theautomatic application of treatment element. The user can activate thetreatment device or devices before or after the drug injection toenhance the tissue response to the injected drug. Such activation can bedone by pressing a button or a sequence of buttons on the drug deliverypen.

For example, in case of an insulin delivery pen, the pen may have aspecial button for triggering a “fast bolus” as compared to regularbolus injection provided by the drug delivery injection pen. The fastinsulin bolus mode can be configured to start one of the abovetreatments parallel to the injection of insulin or short time before orafter the injection of the insulin bolus for a given period of time.This improves or modifies pharmacokinetics or pharmacodynamics ofinsulin administration, tissue blood perfusion and/or absorption in theblood of a patient and is highly advantageous when applied inconjunction with high glycemic index foods. Application of a “fastbolus” may be useful for consumption of high glycemic index foods, wherelarger rapid glucose excursions occurs, but also in most of the cases ofusing insulin boluses for prandial coverage. In some embodiments,application of a “fast bolus” can be set as the default mode of the drugdelivery pen. In some embodiments, the user may apply the tissuetreatment or stimulation before the meal to further increase thetreatment effect.

In some embodiments, at least one effect of the treatments is to reducelocal irritation caused by the infused drug or local inflammationreaction caused by the injection. For example, in case of insulininjection, reducing the period in which the high concentration ofinsulin remains in the tissue may reduce irritation that may be causedby insulin. It can also reduce unwanted effects of the insulin delivery,such as, lipohypertrophy.

Some embodiments of the present invention also provide methods forimproving or modifying a drug's pharmacokinetic or pharmacodynamicprofile in order to reduce time to peak action in the blood of theinjected material by applying a modulation pattern to the infused drug.With this modulation, the injection drug fluid is slightly moved/pulledin and out of the tissue during or after the drug injection process. Insuch embodiments, this method may not require an additional deviceapplied to the skin.

In some embodiments, the drug delivery pen can mechanically attach asmall disposable device to the skin either before, during or afterdelivery of the drug. The disposable device can apply a treatment ortreatments using at least one of the following sources: a heat source(such as a heat resistor), a suction port, for example activated by apump, a mechanical vibration source, an ultrasound excitation source, anultrasound transducer, a light source, a massaging element,electromagnetic radiation source, electric field source, magnetic fieldsource, additional substance and/or a combination of at least two ofsources to improve drug pharmacokinetics. In some embodiments, the smalldisposable device can be attached manually either before or afterinjection of the drug.

In some embodiments, a device for drug injection includes a disposableinjection needle for injecting drug into tissue, a reusable drugdelivery pen for inserting the needle into the patient skin orsubcutaneous layer and for injection of the drug through the needle intoone of the skin and/or subcutaneous tissue layer, a treatment device forapplying a specific treatment or stimulation to the drug injected regionin order to improve drug's pharmacokinetic, pharmacodynamic profileand/or to increase blood perfusion in that region before, during and/orafter the drug injection period to improve drug absorption into theblood system. The needle can be injected automatically at the targetsite using an automatic needle triggering piston or spring. In someembodiments, the needle can be injected at the target site manuallythrough the action of the user inserting the needle independently.

In some embodiments, a device for drug injection includes an injectioncatheter for insertion into the tissue, a drug injection device forinfusing a drug into the injection catheter, a treatment device forapplying a specific treatment or stimulation to the drug infused regionin order to improve, modify and/or stabilize the drug pharmacokinetics,pharmacodynamics, and/or to reduce variations of the drug absorptioninto the blood system.

In some embodiments, a device for drug injection includes at least oneof the following: a display, a button, a memory for boluses, aprocessing unit, a sensor for skin properties, a sensor for treatmentlevel, a glucose sensor, a user interface, wireless connection to a PDAor cell phone for having memory and reminders and remote access tosupport sites.

In some embodiments, the device for drug/insulin injection includes aglucose sensor. The glucose sensor may measure blood glucose level atalternate sites (for example, at sites with reduced blood perfusion,such as arms and legs). The glucose sensor can be provided on theopposite side the injection end.

In some embodiments, the present invention can be configured for a jetinjection. Jet injection involves high pressure injection of material,which obviates the use of needles. This type of injection mode is alsoreferred to as “needle free” or “needleless” injection. In someembodiments, the pen injection device can include a jet injection, inaddition to or in place of, the use of one or more needles. Someexamples of conventional needle-free injection systems include theMedi-Jector VISION® and some products by Antares. Such systems can beadapted for use with the present invention's jet injection system.

In some embodiments, the injection device includes a disposable nozzleand a reservoir having an additional substance. The reservoir is locatedat the nozzle and the additional substance is provided in a single useor single dose amount. The reservoir is located within the body of thedevice and the nozzle features a connector for fluid or othercommunication with the reservoir.

In some embodiments, rather than disposing a nozzle along with anadditional reservoir, an applicator for an additional substance isprovided that is attached to or separate from the device. The nozzle canbe disposed along with a gauge for adjusting the amount of additionalsubstance to be applied. The applicator may be controlled through abutton or other control component. In some embodiments, the gauge can beconfigured as a ring that can be rotated around the applicator button orother control device to adjust the amount that the button is pressedand/or some function of the other control device and/or to adjust thedose of applied additional substance.

In some embodiments, the drug delivery pen can include an adhesivematerial, such as a sticker, for assisting the user to create a skinfold for administration of the drug and/or additional substance.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention is herein described, by way of example only, withreference to the accompanying drawings. With specific reference now tothe drawings in detail, it is stressed that the particulars shown are byway of example and for purposes of illustrative discussion of thepreferred embodiments of the present invention only, and are presentedin order to provide what is believed to be the most useful and readilyunderstood description of the principles and conceptual aspects of theinvention. In this regard, no attempt is made to show structural detailsof the invention in more detail than is necessary for a fundamentalunderstanding of the invention, the description taken with the drawingsmaking apparent to those skilled in the art how the several forms of theinvention may be embodied in practice.

FIGS. 1A-E illustrate an exemplary drug delivery pen combined with amechanism for topical application of an additional substance to the druginjection site, according to some embodiments of the present invention.

FIGS. 2A-C illustrates an exemplary drug delivery pen combined with amechanism for topical application of an additional substance to the druginjection site, according to some embodiments of the present invention.

FIGS. 3A-C illustrates an exemplary drug delivery pen combined with amechanism for topical application of an additional substance to the druginjection site, according to some embodiments of the present invention.

FIGS. 4A-D illustrates an exemplary drug delivery pen combined with amechanism for topical application of an additional substance to the druginjection site, according to some embodiments of the present invention.

FIGS. 5A-C illustrates an exemplary drug delivery pen combined with amechanism for application of a treatment element on the drug injectionsite, according to some embodiments of the present invention.

FIGS. 6A-C illustrates an exemplary drug delivery pen combined with amechanism for application of a treatment element on the drug injectionsite, according to some embodiments of the present invention.

FIGS. 7A-C illustrates an exemplary drug delivery pen and cover combinedwith a mechanism for application of a treatment element on the druginjection site, according to some embodiments of the present invention.

FIGS. 8A-D illustrates an exemplary drug delivery pen combined with amechanism for application of a treatment element on the drug injectionsite, according to some embodiments of the present invention.

FIGS. 9A-C illustrates an exemplary drug delivery pen combined with amechanism for application of a treatment element on the drug injectionsite, according to some embodiments of the present invention.

FIGS. 10A-F illustrates an exemplary treatment element that may becoupled to a drug injection at the drug injection site, according tosome embodiments of the present invention.

FIGS. 11A-E are block diagrams of exemplary drug delivery devices,according to some embodiments of the present invention.

FIGS. 12A-C illustrate an exemplary drug delivery pen combined with amechanism for application of a treatment element on the drug injectionsite, according to some embodiments of the present invention.

FIG. 13 is a flow chart illustrating an exemplary method for controllingtemperature of heating that is provided by a treatment element in orderto prevent degradation of a temperature sensitive drug.

DETAILED DESCRIPTION OF THE INVENTION

The present invention relates to a drug delivery pen or other druginjection devices for the injection of a drug at a drug injection site,where the drug in injection device applies a treatment that can improveinjected drug's pharmacokinetic and/or pharmacodynamic properties. Thefollowing description will refer to a drug injection pen forillustrative, non-limiting purposes, however, as can be understood byone skilled in the art, the present invention is applicable to any otherdrug injection devices.

FIGS. 1A-C are schematic diagrams of an exemplary drug delivery pen 100having a treatment element coupled to the delivery pen, according tosome embodiments of the present invention. FIGS. 1A and 1B depict anexemplary drug delivery pen 100 having a pen shaft 110, an injectionpiston release trigger/button 112 (for actuating a piston pump, forexample, within the housing of the delivery pen), a treatment releasetrigger/button 108 (for actuating a pump for delivering the treatment),a needle opening and a housing 102, treatment delivery openings 104, anda drug dosage selector 106. FIG. 1A is a perspective view of the drugdelivery pen 100. FIG. 1B is a side view of the pen 100.

The drug delivery pen, for the delivery of insulin, may function as dostate of the art drug delivery pens by injecting the selected anddetermined drug dosage 106 and using injection piston release button 112to release the piston (not shown) that presses and/or otherwise placespressure on the drug reservoir syringe or vial, for causing injection ofthe required dosage of drug (not shown) into the targeted area andthrough needle housing 102. In some embodiments, a fluid jet of thedelivered drug can be utilized instead of a syringe to delivery the drugthrough housing 102 to the targeted delivery site. The drug delivery pencan provide an additional treatment element, such as, an anesthetic, adrug for inducing treatment, a drug for improving effectiveness of theprimary drug being injected. The primary drug can be insulin.

The treatment can be delivered over the target tissue using thetreatment delivery openings 104, wherein a fluid treatment substance canbe applied or sprayed onto the tissue. FIG. 1C is a cross-sectional viewof the drug delivery pen 100 showing the treatment element 130 andcomponents thereof. Treatment element 130 includes treatment compartment120, a plurality of valves 122, a pump 126 and a treatment releasebutton 128. In some embodiments, the treatment compartment 120 stores aformulation of a liquid, ointment, solution, aerosol, foam, solid, gelfoam, pressurized liquid, gas, spray, pain reliever drug, analgesic,vasodilatation drug, septic, alcohol, or the like for treatment of theskin tissue area. In some embodiments, treatment may be applied prior toor following deployment of the needle.

Treatment substance stored in compartment 120 can be pumped to thetreatment release openings 104 using schematic pump 126 that isactivated by pressing treatment release button 128. The treatmentrelease button 128 releases valves 122 to deliver treatment liquid fromthe compartment 120 through the tube 124 that leads to openings 104. Thetreatment applied to an area can lead to improved pharmacokinetic and/orpharmacodynamic properties of the primary drug being delivered by way ofinjection. The pathway by which the pharmacodynamic and/orpharmacokinetic properties of the drug are improved may be dependent onthe treatment substance or element utilized.

FIG. 1D is a partial exploded view of a drug delivery pen 140 having amanual injection portion 141, according to some embodiments of thepresent invention. Pen 140 includes a pen body 150, a dosage releasebutton 142, a treatment release button 148, a drug dosage selector 146,and an injection coupling portion 144. Injection coupling portion 144 isa connection mode to securely affix injection portion 141 to the penportion 140. The coupling of the injection portion 141 to the penportion 140 may be accomplished by at least one or more connectingpieces, such as, male/female connectors, threaded connectors, snapconnector(s), turn key connectors, hook connectors or any other suitableconnectors.

Manual injection portion 141 includes a treatment substance reservoir152, a treatment delivery opening 154 and a needle 158. The manualinjection portion 141 can be disposable after a single use. However, theinjection portion 141 can be reusable and can be used a number of timesor repeatedly over a period of time. Prior to drug delivery the drugdelivery pen body 150 is securely coupled to manual injection portion141 allowing a user to use the drug delivery pen 140 by selecting a drugdosage using dosage selector 146. Treatment release button 148 triggersthe release of the treatment substance from the treatment reservoir 152through delivery openings 154. The timing of treatment release can beperformed prior to, during or following drug delivery, or in acombination thereof. Drug delivery can be accomplished by setting thedosage amount using dosage selector 146, manually inserting needle 158into the target site, releasing treatment substance through deliveryopenings 154 and finally delivering the drug with dosage release button142.

FIG. 1E depicts an additional optional embodiment of the manual drugdelivery pen of FIG. 1D. Manual drug delivery pen includes a drugdelivery pen housing 160 and manual injection portion 161. Pen housing160 includes a pen body 170, a dosage release button 162, a drug dosageselector 166, a treatment release button 168, a treatment dosageselector 178, a treatment substance tube 176, and an injection couplingportion 164. The injection coupling portion 164 can be configured tosecurely affix injection portion 161 to the pen body portion 160.Coupling of the injection portion 161 to pen portion 160 can beaccomplished by at least one or more connecting pieces, such as, a maleto female connector(s), threaded connectors, snap connector(s), turn keyconnector(s), hook connectors or any other connection devices.

Manual injection portion 161 is disposable for single use, however,injection portion 161 may be used a number of times, or repeatedly overa continuous period of time. Prior to drug delivery the drug deliverypen body 170 is securely coupled to manual injection portion 161allowing a user to use drug delivery pen 160 by selecting a drug dosageusing drug dosage selector 166. Treatment dosage selector 178 determinesthe dosage of the treatment substance to be released with treatmentrelease button 168. Pressing treatment release button 168 triggers therelease of the treatment substance from the treatment reservoir (notshown) through at least one or more treatment delivery tube 176 thatends in treatment delivery openings 174. Timing of treatment dosageselection and release may be performed prior to, during or followingdrug delivery, or in a combination thereof. Drug delivery isaccomplished by setting the dosage amount using dosage selector 166,manually inserting needle 158 into the target site, releasing treatmentsubstance through delivery openings 174 as described above and finallydelivering the drug with dosage release button 162.

FIGS. 2A-C illustrate an exemplary drug delivery pen according to thepresent invention which is similar to the embodiments depicted in FIGS.1A-C. In FIGS. 2A-C embodiments, the treatment opening is on theopposite side of the needle housing. FIGS. 2A and 2B depict a drugdelivery pen 200 including a pen shaft 210, an injection release button208, a treatment release button 212, a needle opening and a housing 202,a treatment delivery opening 204 and a drug dosage selector 206. FIG. 2Ais a perspective view of the drug delivery pen 200. FIG. 2B is a sideview of pen 200.

The drug delivery, such as insulin delivery, functions in a similarfashion as some conventional pens, such as NovoPen, FlexPen, SanofiAventis pens or the like, by setting the determined drug dosage 206 andpressing an upper button (not shown in FIGS. 2A-C) that pushes thesyringe piston (not shown in FIGS. 2A-C) at the required distance toinject the dosage that was set, such that injection release button 208is not required. For other pens, such as the Autopen 24, after settingthe determined drug dosage 206, the drug is injected by releasing theinjection release button 208 which releases the piston (not shown inFIGS. 2A-C) that pushes the syringe piston to the required distance toinject the desired dosage as set by dial 206. In some pens, for drugdelivery, the drug is accomplished by setting the determined drug dosage206 and pressing the needle release button 208, to release the needle(not shown in FIGS. 2A-C) into the targeted area and through needlehousing 202, thereby injecting the required drug dosage through thatneedle. However, the drug delivery pen according to the presentinvention provides an additional treatment element, such as, in the formof another drug, to induce a treatment for improving the primary drugbeing injected. The above injection pen's configuration and mechanism aswell as other injection devices, such as syringes or jet injectors, canbe configured to be used with devices and methods for applyingadditional treatment to the vicinity of the drug injection site, asdescribed by the present and related applications. In some embodiments,the primary drug can be insulin.

The treatment is delivered over the target tissue using the pen'streatment delivery openings 204, wherein a fluid treatment substance isapplied onto the tissue. FIG. 2C is a cross-sectional view of drugdelivery pen 200 showing the treatment element 230 and componentsthereof. Treatment element 230 includes a treatment compartment 220, aplurality of valves 222, a pump 226, a treatment tube 224 and atreatment release button 228. The treatment compartment 220 stores aformulation, a fluid, such as a liquid, ointment, solution, aerosol,pressurized liquid, gas, spray, pain relieve drug, analgesic,vasodilatation drug, septic, alcohol, or the like for treating the skintissue area. The treatment may be applied prior to or followingdeployment of the needle, in a two step process one end of the pen forsubstance treatment delivery using opening 204 and the opposite end forthe injection using housing 202.

A treatment substance stored in the compartment 220 can be pumped to thetreatment release openings 204 using schematic pump 226 that isactivated by pressing the treatment release button 228. The treatmentrelease button 228 releases valves 222 to deliver treatment liquid fromthe compartment 220 through the tube 224 that leads to the openings 204.In some embodiments, the treatment applied to an area may lead toimproved pharmacokinetic and/or pharmacodynamic properties of theprimary drug being delivered by way of an injection. The pathway bywhich the pharmacodynamic and/or pharmacokinetic properties of the drugare improved may be dependent on the treatment substance or elementutilized.

FIGS. 3A-C illustrate an exemplary pen-type drug delivery device similarto that described in connection with FIGS. 1A-E and 2A-C, however, inthis case, the treatment substance is applied by way of aroller-applicator ball 304 onto the tissue being treated. FIGS. 3A and3B illustrate similar views of drug delivery pen 300. The drug deliveryfunction of pen 300 is similar to the functions of pens shown in FIGS.1A-E and 2A-C. The drug dosage can be controlled and determined using adosage dial 306 that is delivered via the needle housing 302 thatencloses a needle (not shown in FIGS. 3A-C), which is triggered using aninjection release button 312. A treatment substance may be applied tothe injected area either prior to or following injection.

FIG. 3C depicts treatment element 330 including treatment substancecontainer 320 and substance application ball 304. The treatmentcompartment 320 stores a fluid, such as, a liquid, ointment, solution,aerosol, pressurized liquid, gas, spray, pain relieve drug, analgesic,vasodilatation drug, septic, alcohol, or the like for treating the skintissue area. Treatment may be applied with a ball 304 prior to orfollowing deployment of the needle, in at least a two-step process oneend of the pen for substance treatment delivery using ball 304 theopposite end for the injection using housing 302.

FIGS. 4A-C illustrate another exemplary drug delivery pen 400, accordingto some embodiments of the present invention. Treatment substance 430used to improve the pharmacokinetic and/or pharmacodynamic properties ofthe drug being delivered, such as insulin, may come in the form of asolid, gel, gel form, thixotropic solution or the like. The substance430 may be applied to a treatment area either prior to or following drugdelivery using a needle delivered through needle housing 402. Thetreatment substance 430 can be a solid, stick, ointment, solution, painrelieving drug, analgesic, vasodilatation drug, septic, alcohol, or thelike to treat the skin or tissue area. Substance treatment 430 can berubbed, rolled over the treated area or applied in any other suitableway.

The drug delivery pen 400 may be manufactured separately from theindividual treatment substance 430; alternative, the drug delivery pen400 may be manufactured along with treatment substance 430 being coupledthereto. FIG. 4D depicts the treatment substance 430 that can beconfigured to fit over the pen shaft 410 using a sticker, a threading,an adhesive layer, a clip, or any other coupling tools. The pen shaft410 can be pushed through the lumen of treatment substance 430. Thetreatment substance 430 can be configured to fit circumferentiallyaround the pen shaft 410. In some embodiments, a single use or areusable treatment substance 430 can be used with other drug injectiondevices, such as a syringe.

FIG. 5A illustrates an exemplary drug delivery injectable pen having aneedle housing that can accept secondary devices for substance treatmentdeployment or use, according to some embodiments of the presentinvention. Drug delivery pen 500 includes shaft 510 that is configuredto contain a volume of the injectable drug (such as insulin) fordelivery. A dosage dial 506 sets the dosage to be injected with a needlethat is injected via an injection release button 520 through the needleand the needle housing 502.

In some embodiments, the drug delivery pen 500 includes a glucose sensor501 for measuring blood glucose with a finger stick. Glucose sensor 501can be configured to be on the top of the drug delivery pen 500. The pen500 can be used to release a needle that is used to draw a drop of bloodthat may be placed over a finger stick (not shown in FIGS. 5A-C) and isplaced over the glucose sensor 501 for reading the glucose levels in thedrawn blood sample. Additionally, the drop of blood can be applied to afinger stick like glucose sensor inserted into a glucometer type slit,for example on the top of pen 500 (not shown in FIGS. 5A-C).

FIG. 5B depicts a treatment element apparatus 530 that may be coupled tothe drug delivery pen 500, as shown in FIG. 5C, to form drug deliveryapparatus 540. The drug delivery apparatus 540 including the treatmentelement apparatus 530 and drug delivery pen 510 may be single unit.

The treatment element apparatus 530 includes a female connector 524 thatcan be securely coupled to the needle housing 502, which has acorresponding male connector shape. The coupling can be undertaken bythreading, fitting, pin lock assembly, adhesives or any other couplingmethods. The drug delivery pen 530 includes treatment substancedispenser 520 that contains a roll 520 adhered to a plurality oftreatment element 526. The treatment element 526 can be securely placedover the end of needle housing 502. The treatment element 526 can beimplemented in the form of a pad (e.g., releasing an additionalsubstance), a heating pad, a PCB heating element, an optical treatmentelement, an electromagnetic radiation treatment element, an electricalcurrent treatment element, an acoustical treatment element, a massagingtreatment element or an element related to any of the treatment methodsdiscussed above. The treatment element 526 can deliver treatment to atarget tissue prior to injection, following injection, or at the time ofinjection to improve the pharmacodynamic and/or pharmacokineticproperties of an injectable drug. Treatment element 526 can also includea power source to provide the desired treatment power. Treatment elementcan include a control element, such as an electrical circuit, to controlthe treatment profile. Treatment element can be disposable, e.g., singleuse treatment element, whereby after the treatment profile ends, theuser can dispose of the treatment element 526. Treatment element can bereusable, whereby after the treatment profile ends, the user canrecharge it, exchange the power source, or exchange only a portion ofthe treatment element 526 that is disposable and then reload it into anew or the same treatment substance dispenser 520 or a substancedispenser 630 shown in FIG. 6A or any other configuration, as disclosedin the present application.

FIGS. 6A-C illustrate exemplary treatment element dispensers that may becoupled to a drug delivery pen 500, as illustrated in FIG. 5A. FIG. 6Aillustrates a treatment dispenser 630 that is an optional alternative todispenser 530 of FIG. 5B. Treatment dispenser 630 includes stackabletreatment elements 626 that may be coupled to the pen drug deliverydevice. FIG. 6B illustrates how a drug delivery pen is coupled to thetreatment element dispenser 630. Once the treatment element dispenser630 is decoupled from the delivery pen apparatus 650, the needle end ofthe apparatus is coupled with a treatment element 626. The treatmentelement 626 is alignable with the needle of drug delivery pen 650. Thisalignment provides for a drug delivery and treatment apparatus 650 toinduce application of treatment using element 626 prior to, following,or at the same time as undertaking drug delivery with the drug deliverypen 600 in a one step process.

In some embodiments, the drug delivery using the pen 600 and evokingtreatment using element 626 may be undertaken in a two-step process,where treatment element 626 is coupled to a non-needle end of the drugdelivery pen 600. This allows drug delivery and treatment to beperformed individually. For example, one can trigger the drug deliverywith the injection release button 612 and later evoke treatment usingelement 626. The reverse is also true where treatment may precede drugdelivery.

In some embodiments, the treatment element, such as treatment element526 (shown in FIGS. 5A-C) or element 626, is coupled to a single useneedle that is secured to the pen before each dose injection (as shownin FIGS. 1D and 1E), such that when the needle is inserted into thebody, the treatment element is attached to and/or otherwise adheres toor around the injection site, automatically, without the need ofadditional operations by the user.

For any of the embodiments shown herein, the treatment element mayinclude an energy source, which can provide heat, radiation, mechanicalvibrations, suction, magnetic energy, ultrasound, light irradiation, RFirradiation, microwave irradiation, electrical stimulation, or any otherform of energy or combinations of those energy sources. For example, thetreatment element may include a heater to heat the injection site; or asource of optical energy for the energy source, such as a light source,including but not limited to LEDs or laser diodes for example, with oneor more other optical elements; or a micro-wave generator or emitterconfigured to irradiate the injected region with micro-wave radiation;or a radio frequency electromagnetic radiation generator or emitterconfigured to irradiate the injected region with radio frequencyelectromagnetic radiation; or a vibration device configured to vibratethe injected region; or a vacuum device for applying suction to theinjected region; or an electric field generator or emitter configured toapply an electric field to the injected region; or a magnetic fieldgenerator or emitter configured to apply magnetic field to the injectedregion; or an acoustic signal generator or emitter configured to applyacoustic stimulation to the injected region.

FIGS. 7A-C illustrates an exemplary drug delivery pen 700 similar to thepens shown in FIGS. 5A-C and 6A-C, that is coupled to a treatmentelement dispenser 730 as shown in FIG. 7B to create drug delivery andtreatment apparatus 750. The apparatus 750 includes a treatment elementdispenser 730 at the non needle end of drug delivery pen 700. Theapparatus 750 provides the drug delivery pen with an ability to deliverdrug(s) in a chosen dosage while providing the treatment element thatmay improve the pharmacokinetic and/or pharmacodynamic property of thedelivered drug. In some embodiments, the user can store his/hertreatment element(s) in a special case, or in the case of the druginjection device. Before or after the drug injection, the user insertsthe treatment element, as discussed above, into the treatment elementdispenser 730 and applies it to the injection site. In some embodiments,the treatment element can have a similar shape as the treatment elementdispenser 730 and can be coupled directly to the drug delivery pen 700without using the treatment element dispenser as an adaptor.

FIGS. 8A-D illustrate an exemplary treatment apparatus, similar to theone shown in FIGS. 1A-3C, according some embodiments of the presentinvention. FIG. 8A depicts a drug delivery pen 800 used to deliver aninjectable drug. FIGS. 8B and 8C are views of the treatment element 830that can be coupled to the drug delivery pen 800, thus, forming a drugdelivery and treatment apparatus, as shown in FIG. 8A. The treatmentelement 830 can be coupled to the pen 800 via the opening 840 thatreceives the needle end of the drug delivery pen 800. Treatment element830 includes a treatment substance compartment 820 that can be utilizedto store treatment fluid. The treatment compartment 820 stores a fluid,such as gel, foam, liquid, ointment, solution, aerosol, pressurizedliquid, gas, spray, pain relieve drug, analgesic, vasodilatation drug,septic, alcohol, or the like for treating the skin tissue area.Treatment can be applied prior to or following deployment of the needle.

Treatment liquid stored in the compartment 820 can be delivered to thetarget tissue through the opening 804 using pump 826 that is activatedby pressing the treatment release button 828. The treatment releasebutton 828 releases valves 822 to deliver treatment liquid from thecompartment 820 through the tube 824 that leads to the opening 804. Insome embodiments, the amount of treatment liquid can be preset for auser. In some embodiments, a special dial or other means, (not shown inFIGS. 8A-D, but illustrated in FIG. 1E), may be used to set the amountof applied treatment substance. The treatment applied to an area canlead to improved pharmacokinetic and/or pharmacodynamic properties ofthe primary drug being delivered by way of injection (e.g., insulin).The pathway by which the pharmacodynamic and/or pharmacokineticproperties of the drug are improved is optional and may be dependent onthe treatment substance or clement utilized.

FIGS. 9A-C illustrate the drug delivery pen 900 having the treatmentelement provide pressure-related treatment, such as suction, massage, orthe like, according to some embodiments of the present invention. FIG.9A depicts a drug delivery pen and treatment apparatus 950 including adrug delivery pen 900 and a treatment element attachment 930 that can bemechanically coupled. The apparatus 950 can be provided as an assembledor unitary drug delivery device. The apparatus 950 can be coupled to thetreatment element 940 that is made from a pliable material that canwithstand pressure. Such material can be rubber, latex, or any othersuitable material configured to create suction over a given treatmentarea similar to a plunger. The apparatus 950 is placed over thetreatment element 940 and is compressed to create further pressure, asshown in FIGS. 9B and 9C, or suction when the pen is lifted. Suchsuction will bring about vasodilatation in the treated tissue and isconfigured to improve pharmacodynamics and/or pharmacokinetics of thedelivered drug. Drug delivery deployment can be undertaken in thecompressed form of the treatment element 940, as shown in FIG. 9C.

FIGS. 10A-D illustrate a variety of pressure based treatment elements,according to some embodiments of the present invention. FIG. 10A is across-sectional view of the treatment element shown in FIG. 10B. Thetreatment element can be used during drug delivery and includes a lumen1000 allowing the needle to penetrate through. FIG. 10C is across-sectional view of the treatment element shown in FIG. 10D. Thetreatment element of FIG. 10D can be utilized either prior to orfollowing drug delivery in order to create suction over the tissue area.The treatment elements of FIGS. 10A-D can be used to create suction orvacuum in the vicinity of the drug injection site and to induce localvasodilatation.

FIGS. 10E and 10F illustrate an exemplary treatment element configuredas a durable adhesive tape that is used to effectively pinch a fold ofskin while maintaining its shape. The treatment element shown in FIG.10E includes two sticky ends 1050 that are bridged by a malleablesection 1052. Each one of the ends 1050 is placed over a patch of skinwhere an injection for example with a syringe or a drug delivery pen isto be undertaken. Once in place, the ends 1050 are pushed toward eachother by the malleable section 1052 to form a bell type shape. Section1052 can be manufactured from a strong malleable material that can holdits shape, while being repeatedly formed and deformed. FIG. 10F depictsthe treatment element of FIG. 10E in a folded form. Section 1052 can bemoulded and reshaped forming a treatment element for example to bringabout vasodilatation.

FIG. 11A is a block diagram of an exemplary drug delivery apparatus 1100having a treatment element 1102 incorporated into a drug delivery pen1104, wherein the treatment element is integrated into the drug deliverypen, according to some embodiments of the present invention. FIG. 11B isa block diagram of an exemplary drug delivery apparatus 1110 having atreatment element 1112 and a drug delivery device 1114 that areremovably coupled to each other, according to some embodiments of thepresent invention. The drug delivery device 1114 or treatment element1112 can function independently of one another and can be securelycoupled to each other to form a single drug delivery and treatmentapparatus 1110, similar to the embodiment of FIGS. 4A-6C. Drug deliverydevice 1114 can be implemented as a syringe, drug delivery pen, drugdelivery jet injector or the like.

FIG. 11C is a block diagram of an exemplary drug delivery and treatmentapparatus that further includes a sensor 1126, such as a glucose sticksensor, for measuring blood glucose. The drug delivery apparatus 1120communicates with an external processing unit 1130. The processing unitcan be a PDA, a cellular phone, a computer, a laptop or any otherdevice. The unit 1130 includes a controller 1132 and a display 1134. Thecontroller 1132 controls analysis of data received from the drugdelivery apparatus 1120 to determine treatment or dosage form or thelike related to the functioning of drug delivery pen 1124, and treatmentelement 1122. The processing unit 1130 provides the user with dataregarding historical and current use of the drug delivery apparatus1120.

FIG. 11D is a block diagram of an exemplary drug delivery device similarto the device shown in FIG. 11C, where the drug delivery apparatus 1140has an integrated sensor 1146, a processing unit 1150 and a display1148, according to some embodiments of the present invention. Thisallows the user to fully control, visualize all activity related to thedrug delivery pen 1144 or the treatment element 1142.

FIGS. 12A-C schematically illustrate exemplary treatment elementdispensers that may be coupled to a drug injection device 1200 (as shownin FIG. 12C), according to some embodiments of the present invention.FIG. 12A illustrates a treatment element 1210 with a power source 1211.In some embodiments, the treatment element 1210 includes a power sourceand a control element to control a treatment profile. For instance, incase of heating, treatment element 1210 can include a heater to heat thetissue around the injection site to a temperature that improves drug'spharmacokinetics and pharmacodynamics. In case of temperature sensitivedrugs, such as insulin, treatment element 1210 can include a heater toheat the tissue around the injection site to a temperature that improvesdrug's pharmacokinetics and pharmacodynamics, without heating the drugabove a limiting temperature that may degrade it, such as 37° C. in thecase of some types of insulin. Treatment element 1210 may include alsoan adhesive layer on its bottom side covered with a laminate 1212.

In some embodiments the user has a case with one or few treatmentelements 1210. When the user wants to use treatment element over druginjection site, the user takes adaptor 1220, which can be stored in thesame case or a different one, and attaches one treatment clement 1210 toadaptor 1220, as shown in FIG. 12B. Treatment element 1210 can beattached to adaptor 1220 with a weak mechanical locking, such as aplastic clip, or weak adhesive or other ways known in the art. Thenlaminate 1212 can be removed. Afterwards, adaptor 1220 is assembled orthreaded over drug delivery pen or syringe 1230, as shown at FIG. 12C.In some embodiments needle cap 1231, can be removed from the needle.Then, the needle is inserted into injection site tissue, the druginjection device is operated and the drug is injected through needleinto the tissue. During that time, or slightly before or after adaptor1230, is pushed down to the tissue and treatment element 1210 isattached to the tissue around drug injection site.

In some embodiments, the attachment of treatment element 1210 to thetissue is configured to activate it automatically and the treatmentstarts according to a predetermined treatment profile. This function canbe performed, for example, by a small switch which is pressed whentreatment element 1210 is attached to the tissue. In some embodiments,the treatment element 1210 can be activated manually. In someembodiments, treatment element can be controlled and/or programmed for aspecific treatment element through a remote control or a connection toits case. Afterwards, the injection device 1230 and the adaptor 1220 arelifted off, either together or separately, and the treatment element1210 is left attached to the tissue and applies treatment to thevicinity of the drug injection site. The user can remove treatmentelement after treatment ends or later on. In some embodiments, thetreatment element includes an indicator for the user that indicates thebeginning of the treatment and the end of the treatment. In someembodiments, the treatment element 1210 may be disposable.

In some embodiments, the treatment element's 1210 power source 1211 maybe rechargeable, so that after the treatment ends and the user removesit from the skin, it can be put back to the case and/or placed in acharging cradle for recharging which may be disposed in said case. Insome embodiments, the treatment element 1210 may have a disposableportion and a reusable portion. In some embodiments, the drug injectiondevice and at least one treatment element are disposed in the same caseprior to injection. This provides additional comfort for the user andallows the user to use both of them together or one after the other.

FIG. 13 is a flow chart depicting a method for controlling thetemperature of heating provided by a treatment elements that heat theinjection site tissue vicinity in order to prevent degradation of atemperature sensitive drug. As shown in step 1300, a drug is providedfor injection to the patient, where the drug is sensitive to degradationabove a limiting temperature. In step 1301, a treatment element isprovided that features a controllable heating through a controllableheating element. In step 1302, the treatment element is placed inthermal contact with the tissue to be heated, such that heat from thetreatment element is transferred to the tissue to be heated.

In step 1303, a maximum temperature provided by the treatment element iscontrolled, such that the temperature experienced by the drug (that is,in the environment of the drug) does not exceed the limiting temperaturesustainable by the drug before degradation occurs. In some embodiments,he maximum temperature can be calibrated for each drug and/or class ofdrugs. For example, for some types of insulin, the limiting temperatureis about 37° C.

In some embodiments, such control can be provided through amicroprocessor or other processor for controlling the temperature outputby a heating element. A sensor can be provided in order to measure thetemperature at and/or near the tissue being heated, in order todetermine the temperature experienced by the drug.

The treatment element includes one or more materials capable ofgenerating an exothermic reaction, in which the amount of such materialsand/or ratio can be calculated in order for the temperature of thereaction not to exceed the maximum temperature set for the treatmentelement based on the desired limiting temperature of the drug. Theexothermic reaction can be a heat-generating oxidation reaction, forexample, with a mixture of iron powder, activated carbon, salt andwater. As can be understood by one skilled in the art, other suchmixtures of materials can be used.

In some embodiments, the treatment element and the drug delivery pen arenot disposed in the same housing. However, in such cases the user mayforget to apply the treatment to the injection site in some cases,thereby changing the pharmacokinetics, which is undesirable. Therefore,to prevent that the drug delivery pen can include a mechanism forreminding the user to apply the required treatment, before, during orafter injecting the drug into the tissue. In some embodiments, the drugdelivery pen includes a mechanism that identifies whether the treatmentwas applied or not and permits drug injection only when the tissuetreatment was applied. In some embodiments, the drug delivery penincludes, in addition to the drug injection mechanism, a sensor thatindicates whether the treatment was applied or was not applied and aprocessing unit that enables injection of the drug only when the tissuetreatment was applied. Such sensor can be an optical sensor thatmeasures optical properties of the local tissue, or Laser DopplerFlowmeter (“LDF”) that can measure local blood perfusion and identifythat the vasodilatation inducing local treatment was applied and thatthe treatment level was adequate.

Example embodiments of the methods and components of the presentinvention have been described herein. As noted elsewhere, these exampleembodiments have been described for illustrative purposes only, and arenot limiting. Other embodiments are possible and are covered by theinvention. For example, at the present application many of the suggestedmethods and devices can be used for many of the drug injection devices,such as injection pens or syringes or jet injector and other known inthe art injection devices, so although the examples are mainly given forinjection pens they are applied to the other injection devices as well.Such embodiments will be apparent to persons skilled in the relevantart(s) based on the teachings contained herein. Thus, the breadth andscope of the present invention should not be limited by any of theabove-described exemplary embodiments, but should be defined only inaccordance with the following claims and their equivalents.

Any and all references to patents, patent applications, articles andother published and non-published documents made in the presentdisclosure are herein incorporated by reference in their entirety.

1. An apparatus for delivering therapeutic fluid to a patient at aninjection site, comprising: a fluid injection device having a housing,wherein said housing contains: an injector for injecting the therapeuticfluid to the injection site; and a reservoir for containing thetherapeutic fluid; a treatment element coupled to said fluid injectiondevice and configured to apply treatment to the injection site; whereinsaid treatment element is further configured to improve pharmacokineticand/or pharmacodynamics property of the therapeutic fluid. 2-80.(canceled)